International Journal of Psychological and Brain Sciences 2016; 1(2): 32-39 http://www.sciencepublishinggroup.com/j/ijpbs doi: 10.11648/j.ijpbs.20160102.13 Clinical Significant Effect of Chloral Hydrate: Diazepam Combination in the Induction of Sedation During Auditory Brainstem Response in Children with Hearing Loss Hayder Mutter Al-Kuraishy1, Maryam Mohammed Hammed2, Haider W. Alsarhan3 1Department of clinical Pharmacology and Therapeutic, Medical Faculty, College of Medicine, Al-mustansiriya University, Baghdad, Iraq 2B. Sc. College of Pharmacy, Baghdad University, Baghdad, Iraq 3Department of Audiology College of Medicine, Al-mustansiriya, University, Baghdad, Iraq Email address: [email protected] (H. M. Al-Kuraishy), [email protected] (M. M. Hammed), [email protected] (H. W. Alsarhan) To cite this article: Hayder Mutter Al-Kuraishy, Maryam Mohammed Hammed, Haider W. Alsarhan. Clinical Significant Effect of Chloral Hydrate: Diazepam Combination in the Induction of Sedation During Auditory Brainstem Response in Children with Hearing Loss. International Journal of Psychological and Brain Sciences. Vol. 1, No. 2, 2016, pp. 32-39. doi: 10.11648/j.ijpbs.20160102.13 Received: September 6, 2016; Accepted: September 21, 2016; Published: October 11, 2016 Abstract: Hearing loss is the most common sensory disability in the world, hearing loss should be early diagnosed and treated since; it leads to speech and language disorders. Auditory brainstem response (ABR) or Auditory evoked potential (AEP) is a neurologic test done by an audiologist to measure auditory evoke potential. Different types of sedation levels are used during auditory brainstem response test. Therefore, the aim of present study was evaluation of the sedative effect of chloral hydrate during auditory brainstem response (ABR) on children with hearing problems. Randomized selection of 160 children with age ranged between 1-5 years with hearing disorders, they were divided into: Group A: Received 20 mg/Kg chloral hydrate orally. Group B: Received 20 mg/Kg chloral hydrate orally plus 0.5 mg/Kg diazepam rectally. Group C: Received 40 mg/Kg chloral hydrate orally. Group D: Received 40 mg/Kg chloral hydrate orally plus 0.5 mg/Kg diazepam rectally. Regarding ABR testing results, positive ABR test was superior in combined group compared to other groups p=0.005 whereas; negative ABR test was low in combined group compared to other groups p=0.006. At the end of ABR testing 118.52±9.88 of testing children in combined group completed the test compared to other groups p=0.0139 while; 98.21±7.22 of testing children in combined group not completed ABR test compared to other groups p=0.005.In conclusion, combined chloral hydrate plus diazepam give more significant sedative effect than chloral hydrate alone during ABR testing in children with hearing disorders. Keywords: ABR, Chloral Hydrate, Diazepam, Hearing Loss 1. Introduction Hearing loss is the most common sensory disability in the Auditory brainstem response (ABR) or Auditory evoked world, about 270 million people in the world are associated potential (AEP) is a neurologic test done by an audiologist or with hearing dysfunctions either conductive or sensori- an electrophysiology technician to measure auditory evoke neuroal hearing disorders [1]. Hearing loss should be early potential taking out from on-going brain electrical activity diagnosed and treated since; it lead to speech and language and documented by electrodes placed on scalp and done disorders that may cause communication and educational while the person is sleep or at a complete rest. This test is an disorders which may lead to psychological impact, social exogenous response which depends on external factors. It’s stigmatization and social withdrawal [2]. Therefore, general first described in 1971 by Jewett and Williston. The ABR test screening test for hearing loss is recommended either by gives information about brain pathway for hearing and inner automated oto-acoustic or auditory brain stem evoked ear (cochlea) [5, 6]. potential for assessment of auditory function [3, 4]. Different types of sedation levels are used during auditory International Journal of Psychological and Brain Sciences 2016; 1(2): 32-39 33 brainstem response test these are, minimal sedation, in which with gastritis, chest infection or any other serious systemic the sedative drug relief anxiety only [7] moderate sedation, in disease. which the sedative drug cause depression of consciousness Participated children were divided equally and randomly but the patient can response to external stimuli [8] while; into 4 groups, 40 children in each group and assigned as A, B, deep sedation: in which the sedative drug cause depression of C, and D. consciousness, the patient cannot be awakened but can Group A: Received 20 mg/Kg chloral hydrate orally. responds to repeated painful stimuli, the cardiovascular Group B: Received 20 mg/Kg chloral hydrate orally plus function is kept with assistant ventilation [9, 10]. Sedation 0.5 mg/Kg diazepam rectally. scales like MSAT (Minnesota Sedation Assessment Tool), Group C: Received 40 mg/Kg chloral hydrate orally. UMSS (University of Michigan Sedation Scale), Ramsay Group D: Received 40 mg/Kg chloral hydrate orally plus Scale, and the RASS (Richmond Agitation-Sedation Scale) 0.5 mg/Kg diazepam rectally. are used to measure the level of sedation [11]. All children were prepared by give their parents specific Chloral hydrate is an anxiolytic, sedative and hypnotic instructions like weak up the child early and don’t let him agent not related to opiate or benzodiazepine classes, chloral sleep until the time of test, simple breakfast should be taken, hydrate also called (chloral) is an organic compound with the avoid drinking through the last 3 hour before the test. chloride atoms that increasing the lipid solubility and CNS Any child not reaches adequate sedation level within 30 depressant effects, it is formulated as a hydrate to improve minute after drug administrations; we give him additional the stability, chloral hydrate has central nervous system (CNS) dose of chloral hydrate as half of the initial dose. depressant effects by its active metabolite (trichloroethanol), After sedative agent have been given (chloral hydrate that enhances the gamma amino butyric acid (GABA) alone or in combination with diazepam), Ramsey sedation receptor complex and activated chloride current thus; uses of scale was used for assessment of the sedation levels within flumazenil in a case of chloral hydrate intoxication, which is 10 minutes. Ramsey sedation scale (RSS) [17] is scale used a GABA antagonist, pointed to the possible action of chloral to test the arousal and vigilance status; RSS have six different hydrate at GABA level [12, 13]. On the other hand, diazepam levels according to the patient arousal level these are: is a long acting benzodiazepine with anticonvulsant, Level I: Patient is anxious and agitation or restlessness anxiolytic, sedative and muscle relaxant properties [14], it or both. bind to benzodiazepine receptors which are coupled to Level II: Patient is cooperative, oriented and Gamma-amino butyric acid-A (GABA-A) receptors (which tranquilized. are ligand-gated chloride-selective ion channels that are Level III: Patient responds to commands only. activated by GABA, this increase the affinity of GABA to the Level IV: Patient exhibits brisk response to loud GABA receptor. Binding of diazepam to its receptor auditory stimulus. encourages the binding of GABA to GABA receptor that Level V: Patient exhibits sluggish response to loud increase chloride ions conduction across neuronal cell auditory stimulus. membrane; led to hyperpolarization of neuronal membrane Level VI: Patient exhibits no response. potential [15]. Statistical analysis Therefore, the aim of present study was evaluation of the Analysis of data was carried out by using of SPSS-22 sedative effect of chloral hydrate during auditory brainstem (Statistical Packages for Social Sciences- version 22). Data response (ABR) on children with hearing problems. were presented as simple measures of frequency, percentage, mean and standard deviation. The significance of difference 2. Subjects and Methods of different means was tested using ANOVA test for the difference among the independent means. Statistical The study was conducted in Department of Clinical significance was considered when the P value was < 0.05. Pharmacology, College of Medicine, Al-Mustansiriya University in cooperation with ENT unite in Al-Yarmook 3. Results teaching hospital. This study was approved by the specific Scientific Jury and Ethical Committee in the medical board In the present study, 160 children out of 184 completed college of medicine, Al-Mustansiriya, all of enrolled ABR tests since; 24 children were excluded, and they were participants gave informed verbal consent from their parents randomly divided in to four groups regardless of age, gender, for their participations in this study. Randomized selection of weight, family history and drug allergy, figure 1. 160 children with age ranged between 1-5 years, the children In the present study, the age of enrolled children was have no history of any acute or chronic somatic or between 1-5 years, in group (A) age mean was (2.39±1.10), psychological diseases and not take any medication during in group (B) (3.11±0.82), in group (C) (3.09±1.07) and in this study. group (C) (2.99±1.02). Drugs allergy to the different type of An inclusion criterion includes physical state class 1 or 2 drugs were (2) children in group (A), (2) children in group according to American society of anesthesiologists (ASA) (B), (3) children in group (C) and (1) children in group (D). [16], age between 1-5 years, have not been taken sedative or The family history for hearing loss was (2) children in group hypnotic agent within 48hrs and have not been diagnosed C and (1) child in group D, table (1). 34 Hayder Mutter Al-Kuraishy et al.: Clinical Significant Effect of Chloral Hydrate: Diazepam Combination in the Induction of Sedation During Auditory Brainstem Response in Children with Hearing Loss Figure 1.